If you feel a bulge in the vaginal area, you may be experiencing pelvic organ prolapse. This is a very common condition, occurring in 35-65% of women. Loss of pelvic support results from stretching or weakening of the muscles, ligaments, or nerves responsible for holding up the bladder, vagina, uterus, and bowel. This weakening can result in the pelvic organs "dropping" or bulging into the vagina. Patients with prolapse usually notice that activities such as standing, lifting, or straining can make the bulge larger. Prolapse is usually related to the stretching that occurs during childbirth and can also occur after hysterectomy.

How is pelvic organ prolapse evaluated?

Successful treatment begins with a through evaluation. This includes a detailed questionnaire, careful history, and a complete physical exam. The physical exam will include collection of a urine specimen, a pelvic exam, and a neurologic exam. In some instances, further evaluation may be required and can include urodynamic studies to measure the pressure and function of the bladder and urethra and cystoscopy to look inside the bladder.

What treatments are offered at the University of Maryland?

Mild stages of prolapse do not usually cause discomfort and often do not require treatment. More advanced stages of prolapse most commonly cause the symptom of tissue bulging from the vagina. Sometimes the vaginal bulge will drop down enough to kink off the urethra, and some woman will push the bulge in to urinate.

There is a relatively short list of treatment options for prolapse. A woman can choose to do nothing, wear a rubber dish (called a pessary) that fits in the vagina and supports the pelvic organs, or have surgery to fix the prolapse. If the prolapse is not bothering you, then in general, no treatment is necessary. The exception is the condition mentioned above in which the urethra is kinked off by the bulge so that the bladder does not empty completely. This situation usually requires some type of intervention.

There are several types of surgical techniques available. Some of the surgeries require a hysterectomy, while others do not. The operative procedures are either done through the vagina or through the abdomen, and the goal is restoration of the support of the apex (or top) of the vagina. We are now able to perform the abdominal procedures using the da Vinci® robotic system in selected patients, which utilizes a state-of-the-art minimally invasive approach to surgically correct vaginal vault prolapse by resupporting the vagina to the sacrum using a polypropylene mesh. Minimally invasive surgical techniques tend to cause less discomfort and patients generally have a shorter recovery time.

There is not one type of surgery that is appropriate for everyone. You and your physician will decide on an individualized treatment plan depending on your stage of prolapse, your complaints, and most importantly, your preferences.

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